In the face of crisis, the NHS has rapidly implemented innovation in all corners of the sector, but we must ensure digital tech is used safely.

The NHS has come a long way in the last five months. In seeing off the first wave of Covid-19 it has undergone a thorough self-examination as to the delivery of health and care in the 21st century.

It is perhaps in the use of digital technology where we can see the most rapid change. GPs are currently performing 90 per cent of their consultations via video, something thought unthinkable at the start of the year, hospital staff are utilising new apps to communicate and teams are using a range of time saving tools that can massively free up time for direct patient care. Tools such as Microsoft Teams have become the mainstay for working in the NHS, usage of the software has increased exponentially since the start if the outbreak, within one week of its roll out to NHS mail users, registrations went up tenfold to over 40,000 and there are now over one million NHS log in accounts.

Looking to capitalise on the surge in digital uptake in recent months, Health Secretary Matt Hancock has laid out his roadmap for the future of the NHS – with digital consultations becoming the norm and service delivery models being orientated to digital in every possible corner. The Health Secretary stated that he wanted to “double down” on the implementation of digital technology seen in response to Covid-19. In response to Mr Hancock’s desire to remove pagers and fax machines from the NHS by 2021, NHSx have recently launched a clinical communications framework to help drive the move away from pagers towards digital communication platforms.

Long overdue progress

This will be music to the ears of the many tech entrepreneurs that have long tried to pitch their innovations into the health sector but have repeatedly been met with a health system unable to change.

“For years we have desperately needed these digital solutions,” says Dr Tom Oakely, former NHS Radiologist and current CEO of Feedback Medical. When Tom worked on the NHS frontline, he was often faced with archaic practices. In particular, he identified a major problem for clinicians looking to share patient imaging. “Sharing images between different hospitals was a major hindrance, and yet medical imaging is such a crucial part of what we do, every patient coming into hospital will get imaging of some form or another.” And yet, it can often take hours to share medical imaging between hospitals, in some cases clinicians have had to burn images onto CDs and send them with the patient in the ambulance. Tom says, “you just found yourself thinking, this is completely insane and putting patients at needless risk.”

This was the genesis for the Bleepa app, Feedback Medical’s flagship product, that combines instant messaging with the ability to share medical grade diagnostic images.  Cases can be discussed through its secure instant messaging and image annotation, allowing comments and treatment decisions to be communicated instantly between team members. Of late, the app has raised the bar for medical communication platforms, becoming the first to achieve regulatory compliance for imaging standards and hold a CE mark.

The app has seen a surge in uptake necessitated by the Covid-19 pandemic. Senior consultants, who are possibly at risk of Covid due to their age, have used the app to continue to make informed management decisions to junior colleagues on wards. It seems that many clinicians are now enjoying the added flexibility that the technology brings reducing the need for physical real estate and freeing up time for better patient care. But while Tom would certainly want technology like Bleepa to be in all corners of the health sector, he knows that any medical device, digital or otherwise, must adhere to regulatory standards. 

Ensuring certified safety

There is a danger that, in this rush to implement digital technology, people forget that digital medical devices are still medical devices – and we must ensure that they are implemented with safety at their core. While we all want to see this pace of digital uptake maintained, we cannot rush into things while patient safety is at stake.

As Tom highlights, the medical device directive is actually very clear on this, “the display of  digital patient images for diagnostic purposes, is considered a medical device functionality by the Medical Device Directive.” A CT or MRI scan cannot simply be exchanged using a static from a photograph, these images often are multi-layered and are extremely detailed. Additional capacity is required to view the image as detailed as if you were viewing on a screen in a hospital – this is what the Bleepa app achieves and its CE Certification is clear confirmation of this. It remains the only such device with this level of certification on the recent NHSx Clinical Communication Framework. Using a product to share any digital image for a diagnostic purpose, such as clinical chat or MDT, without certification equates to  off-licence use, putting patients at risk and exposing clinicians and their employing trusts to potential civil claims .

Education and regulation

Regulation itself should not be seen as a barrier to innovation, but rather an enabler. Tech entrepreneurs, who certainly have good intentions, are trying to implement digital innovation at pace without truly understanding the regulatory environment in which they operate.

As Tom says, “often when you are pushing boundaries, you can stray into areas without realising, it is important to stop, reflect and ensure that it is being done safely and correctly.”

Perhaps we are moving at the edges of markets the health sector has had little experience in interacting with. Hospital procurement teams would understand the certification requirements if they were purchasing a PACS, but this knowledge has not yet permeated into PACS with messaging and wider digital image sharing. Trusts and clinicians must be mindful of regulation  as they implement these solutions and be aware of potential risks associated with using unregulated products.

We should not stifle the ambition of innovators, nor should we dampen the desire of NHS staff looking to implement solutions, rather we should encourage it wherever possible, especially where regulatory frameworks already exist to ensure safety. Harnessing this innovative vigour has formed the basis of the newly published NHS People Plan and of Matt Hancock’s tech vision for the health and care sector. But now that we are spoilt for choice with digital tech, the health sector must come together to encourage responsible and safe use – ensuring proper certification on devices is one crucial part of this.

There is an abundance of opportunity here. A real chance to harness innovation and make lasting change to the way in which health and care is delivered, during this pandemic and beyond. But now that digital technology has the attention of the entire sector, we should take the opportunity to do it properly, ensuring that all innovators, clinicians and health providers are adhering to safeguards that protect staff and ensure patient safety.